叶酸片联合阿托伐他汀钙片对高同型半胱氨酸血症患者颈总动脉内膜中层厚度影响的长期观察

林晨志+黄雅玲

[摘要] 目的 探讨叶酸片联合阿托伐他汀钙片能否对延缓高同型半胱氨酸血症（HCY）患者颈总动脉内膜中层增厚产生协同疗效。 方法 选取高HCY患者90例，随机分为三组，每组30例。联合组给予叶酸片和阿托伐他汀钙片治疗，他汀组给予阿托伐他汀钙片治疗，叶酸组给予叶酸片治疗。观察三组在治疗前后不同时间点上，颈总动脉内膜中层厚度（IMT）、血浆HCY、血总胆固醇（TC）、低密度脂蛋白胆固醇（LDL）、甘油三酯（TG）以及超敏C反应蛋白（hsCRP）的变化情况。 结果 在治疗后的各观察时间点上组间比较，联合组的血浆HCY水平较叶酸组，均无明显降低（P>0.05）；联合组的血TC、LDL、TG水平较他汀组，均无统计学意义（P>0.05）。在治疗后24个月观察时间点上组间比较：联合组的IMT小于他汀组（P<0.05），联合组的IMT小于叶酸组（P<0.05）。 结论 叶酸联合阿托伐他汀钙片能明显降低高同型半胱氨酸血症患者血同型半胱氨酸水平和血脂水平，联合治疗减少颈总动脉内膜中层厚度的远期效果更显著，更有利于延缓动脉粥样硬化。

[关键词] 叶酸；阿托伐他汀钙；同型半胱氨酸；颈动脉；中层内膜厚度

[中图分类号] R543.4 [文献标识码] A [文章编号] 2095-0616（2017）06-11-05

[Abstract] Objective To study the synergistic effect of folic acid tablets in combination with atorvastatin calcium tablet to common carotid artery intima-media thickness（CCA-IMT） of patients with hyperhomocysteinemia. Methods 90 patients with high HCY were randomly divided into three groups，30 cases in each group.Patients in joint group were treated with folic acid tablets and atorvastatin calcium，patients in statin group were treated with atorvastatin calcium， patients in folic acid group were treated with folic acid tablets.The common carotid artery intima-media thickness （IMT），plasma HCY，blood total cholesterol（TC），low-density lipoprotein cholesterol （LDL），triglycerides （TG） and hypersensitive c-reactive protein （hsCRP） changes of the three groups at different time points before and after treatment were observed. Results After treatment，the comparison of each observation point was as follows：Compared with the folic acid group，there were no significantly decreased on plasma HCY levels of joint group（P>0.05）.Compared with the statin group， there were no significantly decreased on blood TC，LDL，TG level of joint group（P>0.05）.24 months after treatment group，comparison between observation time point was as follows：IMT of joint group was less than that of statin group（P<0.05），the IMT of joint group was less than that of folic acid group（P<0.05）. Conclusion Folic acid tablets in combination with atorvastatin calcium tablet can obviously reduce homocysteine levels in patients with blood homocysteine levels and blood lipid levels.Combination therapy to reduce the forward of the common carotid artery intima-media thickness effect is more prominent，and it is more conducive to postpone sclerosis of arterial congee appearance.

[Key words] Folic acid；Atorvastatin calcium；Homocysteine；Carotid artery；Middle membrane thickness

隨着社会的发展，缺血性心脏病及脑血管疾病已成为全球的第一、二位的死亡原因，而缺血性心

脏病及脑血管疾病共同的病理基础是动脉粥样硬化。动脉粥样硬化形成的病理生理过程是脂质成分（以胆固醇为主）在动脉壁的沉积。研究显示，血清总胆固醇水平与动脉粥样硬化的发生、发展密切相关[1]。高同型半胱氨酸（HCY）血症可引起血管内皮功能损害[2]，其已成为继高血压高血脂糖尿病吸烟肥胖等因素之后，动脉粥样硬化的又一独立危险因子[3]。高胆固醇血症和高同型半胱氨酸血症叠加将加速全身动脉粥样硬化的发生及发展。作为全身动脉的组成部分，颈动脉粥样硬化程度对全身动脉病变发生有着重要的参考价值，并与心脑血管疾病的发生有着很强的相关性[4]，尤其颈动脉内膜中层厚度（IMT）是反映动脉硬化的敏感特异性指标。颈动脉IMT能够独立预测心脑血管病事件[5]。因此，颈动脉彩超作为一种无创性的检查，适用于检测颈动脉IMT，而颈总动脉IMT由于容易获得并且可重复性高，临床上常用的观察指标。通过测量治疗前后颈总动脉IMT变化，判定治疗效果。本研究旨在通过观察高HCY患者治疗前后血浆HCY、血脂水平和颈总动脉IMT的变化，了解叶酸片联合阿托伐他汀钙片能否对延缓或逆转高HCY患者颈总动脉IMT抗动脉粥样硬化产生协同疗效。现报道如下。